Systems and methods for robotic arm alignment and docking

ABSTRACT

Certain aspects relate to systems and techniques for alignment and docking of robotic arm of a robotic system for surgery. In one aspect, the system includes a robotic arm, a drive mechanism attached to the robotic arm, and a cannula. The system may further include a first sensor coupled to either the robotic arm or the drive mechanism configured to direct automatic movement of the robotic arm towards the cannula, and a second sensor, that is different than the first sensor, coupled to either the robotic arm or the drive mechanism configured to direct manual movement of the robotic arm towards the cannula.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of U.S. Provisional Application No. 62/866,897, filed Jun. 26, 2019, which is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to systems and methods for the alignment and docking of robotic arm, and more particularly to combined sensor assisted and computer assisted alignment and/or docking of a robotic arm with a target.

BACKGROUND

Before performing a surgical procedure, robotic arm(s) that support surgical instrument(s) may be “docked” to corresponding target(s) placed on a patient. The target may include a port such as a cannula or an access point such as a natural orifice. When the target is a cannula, the docking of a robotic arm to the cannula may include coupling or otherwise latching the robotic arm to the cannula. The docking process can occur before the start of any surgical procedure, or mid-procedure (e.g., a surgeon may need to use different cannulas and re-dock one or more robotic arms). The docking process is typically performed manually and may involve a surgeon or clinician moving a robotic arm into alignment with a cannula to dock the robotic arm to the cannula. Once the docking process is completed, a surgical instrument can be inserted coaxially to the cannula and to gain access to an internal region of the patient.

SUMMARY

The systems, methods and devices of this disclosure each have several innovative aspects, no single one of which is solely responsible for the desirable attributes disclosed herein.

In a first aspect, a robotic surgery system includes a robotic arm; a drive mechanism attached to the robotic arm; a cannula; a first sensor coupled to either the robotic arm or the drive mechanism; a second sensor, that is different than the first sensor, coupled to either the robotic arm or the drive mechanism; at least one computer-readable memory having stored thereon executable instructions; and one or more processors in communication with the at least one computer-readable memory. The one or more processors can be configured to execute the instructions to cause the system to at least: direct automatic movement of the robotic arm towards the cannula based on data from the first sensor; and direct manual movement of the robotic arm towards the cannula based on data from the second sensor.

The robotic surgery system may further include one or more of the following features in any combination: (a) wherein the first sensor comprises a vision-based sensor; (b) wherein the vision-based sensor comprises a camera; (c) wherein the vision-based sensor is attached to the drive mechanism; (d) wherein the cannula further comprises a fiducial configured to be detected by the vision-based sensor; (e) wherein the second sensor comprises a non-vision based sensor; (f) wherein the non-vision based sensor comprises a force or torque sensor; (g) wherein the non-vision based sensor is attached to the drive mechanism; (h) wherein the non-vision based sensor comprises a switch; (i) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (j) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

In another aspect, a robotic surgery system includes a robotic arm; a drive mechanism attached to the robotic arm; a cannula; a first sensor that is coupled to either the robotic arm or the drive mechanism; a second sensor that is coupled to either the robotic arm or the drive mechanism; at least one computer-readable memory having stored thereon executable instructions; and one or more processors in communication with the at least one computer-readable memory. The one or more processors can be configured to execute the instructions to cause the system to at least: automatically move the robotic arm in a first mode towards the cannula based data from the first sensor; and manually move the robotic arm in a second mode based on data from the second sensor.

The robotic surgery system may further include one or more of the following features in any combination: (a) wherein the first sensor comprises a vision-based sensor; (b) wherein the vision-based sensor comprises a camera; (c) wherein the vision-based sensor is attached to the drive mechanism; (d) wherein the cannula further comprises a fiducial designed to be detected by the vision-based sensor; (e) wherein the second sensor comprises a non-vision based sensor; (f) wherein the non-vision based sensor comprises a force or torque sensor; (g) wherein the non-vision based sensor comprises a switch; (h) wherein the non-vision based sensor is attached to the drive mechanism; (i) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (j) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

Another aspect relates to a surgical method of docking a robotic surgery system, the method including: automatically translating a robotic arm with a drive mechanism towards a cannula positioned at least partially within a patient; switching the robotic surgery system to a manual mode; manually translating the drive mechanism towards the cannula; and manually docking the drive mechanism onto the cannula.

The aspect described in the above paragraph may also include one or more of the following features in any combination: (a) wherein automatically translating the robotic arm with the drive mechanism towards the cannula positioned at least partially within the patient comprises aligning the drive mechanism with the cannula; (b) wherein switching the robotic surgery system to the manual mode comprises one or more of activating a touch sensor, activating a switch, or applying force to a load cell; (c) wherein automatically translating the robotic arm with the drive mechanism towards the cannula positioned at least partially within the patient comprises utilizing a vision-based sensor positioned on the robotic arm or the drive mechanism; (d) wherein the vision-based sensor comprises a camera; (e) wherein the vision-based sensor is attached to the drive mechanism; (f) wherein the cannula comprises a fiducial designed to be detected by the vision-based sensor; (g) wherein switching the robotic surgery system to a manual mode comprises activating a non-vision based sensor; (h) wherein the non-vision based sensor comprises a force or torque sensor; (i) wherein the non-vision based sensor is attached to the drive mechanism; (j) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (k), wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

Another aspect relates to a surgical method of docking a robotic surgery system, the method including: manually translating a robotic arm with a drive mechanism towards a cannula positioned at least partially within a patient; switching the robotic surgery system to an automatic mode; automatically translating or orienting the drive mechanism towards the cannula; switching the robotic surgery system to a manual mode; and manually docking the drive mechanism onto the cannula.

The aspect described in the above paragraph may also include one or more of the following features in any combination: (a) wherein automatically translating or orienting the robotic arm with the drive mechanism towards the cannula positioned at least partially within the patient comprises aligning the drive mechanism with the cannula; (b) wherein switching the robotic surgery system to the manual mode or the automatic mode comprises one or more of activating a touch sensor, activating a switch, or applying force to a load cell; (c) wherein automatically translating or orienting with the drive mechanism towards the cannula positioned at least partially within the patient comprises utilizing a vision-based sensor positioned on the robotic arm or the drive mechanism; (d) wherein the vision-based sensor comprises a camera; (e) wherein the vision-based sensor is attached to the drive mechanism; (f) wherein the cannula comprises a fiducial designed to be detected by the vision-based sensor; (g) wherein switching the robotic surgery system to a manual mode comprises activating a non-vision based sensor; (h) wherein the non-vision based sensor comprises a force or torque sensor; (i) wherein the non-vision based sensor is attached to the drive mechanism; (j) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (k) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

Another aspect relates to a surgical method of docking a robotic surgery system, the method including: translating a robotic arm with a drive mechanism towards a cannula positioned at least partially within a patient; switching the robotic surgery system to a hybrid mode; manually translating the drive mechanism towards the cannula, while automatically orienting the drive mechanism towards the cannula; switching the robotic surgery system to a manual mode; manually translating the drive mechanism towards the cannula; and manually docking the drive mechanism onto the cannula.

The aspect described in the above paragraph may also include one or more of the following features in any combination: (a) wherein translating the robotic arm with the drive mechanism towards the cannula positioned at least partially within the patient is performed automatically; (b) wherein automatically translating with the drive mechanism towards the cannula positioned at least partially within the patient comprises utilizing a vision-based sensor positioned on the robotic arm or the drive mechanism; (c) wherein the vision-based sensor comprises a camera; (d) wherein the vision-based sensor is attached to the drive mechanism; (e) wherein the cannula comprises a fiducial designed to be detected by the vision-based sensor; (f) wherein translating the robotic arm with the drive mechanism towards the cannula positioned at least partially within the patient is performed manually; (g) wherein switching the robotic surgery system to the hybrid mode or the manual mode comprises one or more of activating a touch sensor, activating a switch, or applying force to a load cell; (h) wherein switching the robotic surgery system to a manual mode comprises activating a non-vision based sensor; (i) wherein the non-vision based sensor comprises a force or torque sensor; (j) wherein the non-vision based sensor is attached to the drive mechanism; (k) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (l) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

In another aspect, a robotic surgery system includes a robotic arm; a drive mechanism attached to the robotic arm; a vision based sensor positioned on the drive mechanism; a non-vision based sensor positioned on the drive mechanism; at least one computer-readable memory having stored thereon executable instructions; and one or more processors in communication with the at least one computer-readable memory. The one or more processors can be configured to execute the instructions to cause the system to at least: guide automatic movement of the robotic arm or the drive mechanism towards an instrument at least partially positioned within a patient based on the vision based sensor; and switch the robotic surgery system to a manual mode so that the system can be moved manually towards an instrument positioned at least partially within the patient based on data from the non-vision based sensor.

The robotic surgery system may further include one or more of the following features in any combination: (a) wherein the non-vision based sensor comprises a force or torque sensor; (b) wherein the non-vision based sensor comprises a switch; (c) wherein the non-vision based sensor comprises a single sensor; (d) wherein the non-vision based sensor comprises a sensor array; (e) wherein the non-vision based sensor comprises a sensor array; and/or (f) wherein the vision-based sensor comprises a camera.

In yet another aspect, a non-transitory computer readable storage medium having stored thereon instructions that, when executed, cause a processor of a device to at least: automatically translate a robotic arm with a drive mechanism towards a cannula positioned at least partially within a patient; switch the robotic surgery system to a manual mode; manually translate the drive mechanism towards the cannula; and manually dock the drive mechanism onto the cannula.

The aspect described in the above paragraph may also include one or more of the following features in any combination: (a) wherein the instructions, when executed, further cause the processor to align the drive mechanism with the cannula; (b) wherein the instructions, when executed, further cause the processor to activate a touch sensor, activate a switch, or apply force to a load cell; (c) wherein the instructions, when executed, further cause the processor to activate a vision-based sensor positioned on the robotic arm or the drive mechanism; (d) wherein the vision-based sensor comprises a camera; (e) wherein the vision-based sensor is attached to the drive mechanism; (f) wherein the cannula comprises a fiducial designed to be detected by the vision-based sensor; (g) wherein the instructions, when executed, further cause the processor to activate a non-vision based sensor; (h) wherein the non-vision based sensor comprises a force or torque sensor; (i) wherein the non-vision based sensor is attached to the drive mechanism; (j) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (k) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

In another aspect, a non-transitory computer readable storage medium having stored thereon instructions that, when executed, cause a processor of a device to at least: manually translate a robotic arm with a drive mechanism towards a cannula positioned at least partially within a patient; switch the robotic surgery system to an automatic mode; automatically translate or orient the drive mechanism towards the cannula; switch the robotic surgery system to a manual mode; and manually dock the drive mechanism onto the cannula.

The robotic surgery system may further include one or more of the following features in any combination: (a) wherein the instructions, when executed, further cause the processor to align the drive mechanism with the cannula; (b) wherein the instructions, when executed, further cause the processor to activate a touch sensor, activate a switch, or apply force to a load cell; (c) wherein the instructions, when executed, further cause the processor to activate a vision-based sensor positioned on the robotic arm or the drive mechanism; (d) wherein the vision-based sensor comprises a camera; (e) wherein the vision-based sensor is attached to the drive mechanism; (f) wherein the cannula comprises a fiducial designed to be detected by the vision-based sensor; (g) wherein the instructions, when executed, further cause the processor to activate a non-vision based sensor; (h) wherein the non-vision based sensor comprises a force or torque sensor; (i) wherein the non-vision based sensor is attached to the drive mechanism; (j) wherein the non-vision based sensor is positioned on a front end of the drive mechanism; and/or (k) wherein the non-vision based sensor is positioned on a back end of the drive mechanism.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction with the appended drawings, provided to illustrate and not to limit the disclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arranged for diagnostic and/or therapeutic bronchoscopy.

FIG. 2 depicts further aspects of the robotic system of FIG. 1.

FIG. 3 illustrates an embodiment of the robotic system of FIG. 1 arranged for ureteroscopy.

FIG. 4 illustrates an embodiment of the robotic system of FIG. 1 arranged for a vascular procedure.

FIG. 5 illustrates an embodiment of a table-based robotic system arranged for a bronchoscopic procedure.

FIG. 6 provides an alternative view of the robotic system of FIG. 5.

FIG. 7 illustrates an example system configured to stow robotic arm(s).

FIG. 8 illustrates an embodiment of a table-based robotic system configured for a ureteroscopic procedure.

FIG. 9 illustrates an embodiment of a table-based robotic system configured for a laparoscopic procedure.

FIG. 10 illustrates an embodiment of the table-based robotic system of FIGS. 5-9 with pitch or tilt adjustment.

FIG. 11 provides a detailed illustration of the interface between the table and the column of the table-based robotic system of FIGS. 5-10.

FIG. 12 illustrates an alternative embodiment of a table-based robotic system.

FIG. 13 illustrates an end view of the table-based robotic system of FIG. 12.

FIG. 14 illustrates an end view of a table-based robotic system with robotic arms attached thereto.

FIG. 15 illustrates an exemplary instrument driver.

FIG. 16 illustrates an exemplary medical instrument with a paired instrument driver.

FIG. 17 illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument.

FIG. 18 illustrates an instrument having an instrument-based insertion architecture.

FIG. 19 illustrates an exemplary controller.

FIG. 20 depicts a block diagram illustrating a localization system that estimates a location of one or more elements of the robotic systems of FIGS. 1-10, such as the location of the instrument of FIGS. 16-18, in accordance to an example embodiment.

FIG. 21A illustrates an example embodiment of an ADM attached to a robotic arm.

FIG. 21B illustrates a top perspective view of an embodiment of an ADM of FIG. 21A.

FIG. 21C illustrates a bottom perspective view of an embodiment of an ADM of FIGS. 21A-21B.

FIG. 22 illustrates a ADM and a cannula at a first position in an exemplary docking method in accordance with aspects of this disclosure.

FIG. 23 illustrates the ADM and the cannula aligned in a second position in the exemplary docking method in accordance with aspects of this disclosure.

FIG. 24 illustrates the ADM and the cannula docked in the exemplary docking method in accordance with aspects of this disclosure.

FIG. 25 is a flowchart illustrating an example technique for aligning an ADM with a cannula in accordance with aspects of this disclosure.

FIG. 26 is a flowchart illustrating another example technique for aligning an ADM with a cannula in accordance with aspects of this disclosure.

FIG. 27 is a flowchart illustrating yet another example technique for aligning an ADM with a cannula in accordance with aspects of this disclosure.

DETAILED DESCRIPTION 1. Overview.

Aspects of the present disclosure may be integrated into a robotically-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive, such as laparoscopy, and non-invasive, such as endoscopy, procedures. Among endoscopic procedures, the system may be capable of performing bronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system may provide additional benefits, such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform the procedure from an ergonomic position without the need for awkward arm motions and positions. Still further, the system may provide the physician with the ability to perform the procedure with improved ease of use such that one or more of the instruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with the drawings for purposes of illustration. It should be appreciated that many other implementations of the disclosed concepts are possible, and various advantages can be achieved with the disclosed implementations. Headings are included herein for reference and to aid in locating various sections. These headings are not intended to limit the scope of the concepts described with respect thereto. Such concepts may have applicability throughout the entire specification.

A. Robotic System—Cart.

The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure. FIG. 1 illustrates an embodiment of a cart-based robotically-enabled system 10 arranged for a diagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, the system 10 may comprise a cart 11 having one or more robotic arms 12 to deliver a medical instrument, such as a steerable endoscope 13, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the cart 11 may be positioned proximate to the patient's upper torso in order to provide access to the access point. Similarly, the robotic arms 12 may be actuated to position the bronchoscope relative to the access point. The arrangement in FIG. 1 may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures. FIG. 2 depicts an example embodiment of the cart in greater detail.

With continued reference to FIG. 1, once the cart 11 is properly positioned, the robotic arms 12 may insert the steerable endoscope 13 into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope 13 may comprise at least two telescoping parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument driver from the set of instrument drivers 28, each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers 28, which facilitates coaxially aligning the leader portion with the sheath portion, creates a “virtual rail” 29 that may be repositioned in space by manipulating the one or more robotic arms 12 into different angles and/or positions. The virtual rails described herein are depicted in the Figures using dashed lines, and accordingly the dashed lines do not depict any physical structure of the system. Translation of the instrument drivers 28 along the virtual rail 29 telescopes the inner leader portion relative to the outer sheath portion or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 may be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail 29 as shown represents a compromise between providing physician access to the endoscope 13 while minimizing friction that results from bending the endoscope 13 into the patient's mouth.

The endoscope 13 may be directed down the patient's trachea and lungs after insertion using precise commands from the robotic system until reaching the target destination or operative site. In order to enhance navigation through the patient's lung network and/or reach the desired target, the endoscope 13 may be manipulated to telescopically extend the inner leader portion from the outer sheath portion to obtain enhanced articulation and greater bend radius. The use of separate instrument drivers 28 also allows the leader portion and sheath portion to be driven independently of each other.

For example, the endoscope 13 may be directed to deliver a biopsy needle to a target, such as, for example, a lesion or nodule within the lungs of a patient. The needle may be deployed down a working channel that runs the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying a nodule to be malignant, the endoscope 13 may endoscopically deliver tools to resect the potentially cancerous tissue. In some instances, diagnostic and therapeutic treatments can be delivered in separate procedures. In those circumstances, the endoscope 13 may also be used to deliver a fiducial to “mark” the location of the target nodule as well. In other instances, diagnostic and therapeutic treatments may be delivered during the same procedure.

The system 10 may also include a movable tower 30, which may be connected via support cables to the cart 11 to provide support for controls, electronics, fluidics, optics, sensors, and/or power to the cart 11. Placing such functionality in the tower 30 allows for a smaller form factor cart 11 that may be more easily adjusted and/or re-positioned by an operating physician and his/her staff. Additionally, the division of functionality between the cart / table and the support tower 30 reduces operating room clutter and facilitates improving clinical workflow. While the cart 11 may be positioned close to the patient, the tower 30 may be stowed in a remote location to stay out of the way during a procedure.

In support of the robotic systems described above, the tower 30 may include component(s) of a computer-based control system that stores computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, etc. The execution of those instructions, whether the execution occurs in the tower 30 or the cart 11, may control the entire system or sub-system(s) thereof. For example, when executed by a processor of the computer system, the instructions may cause the components of the robotics system to actuate the relevant carriages and arm mounts, actuate the robotics arms, and control the medical instruments. For example, in response to receiving the control signal, the motors in the joints of the robotics arms may position the arms into a certain posture.

The tower 30 may also include a pump, flow meter, valve control, and/or fluid access in order to provide controlled irrigation and aspiration capabilities to the system that may be deployed through the endoscope 13. These components may also be controlled using the computer system of the tower 30. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope 13 through separate cable(s).

The tower 30 may include a voltage and surge protector designed to provide filtered and protected electrical power to the cart 11, thereby avoiding placement of a power transformer and other auxiliary power components in the cart 11, resulting in a smaller, more moveable cart 11.

The tower 30 may also include support equipment for the sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronics equipment for detecting, receiving, and processing data received from the optical sensors or cameras throughout the robotic system 10. In combination with the control system, such optoelectronics equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower 30. Similarly, the tower 30 may also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower 30 may also be used to house and position an EM field generator for detection by EM sensors in or on the medical instrument.

The tower 30 may also include a console 31 in addition to other consoles available in the rest of the system, e.g., console mounted on top of the cart. The console 31 may include a user interface and a display screen, such as a touchscreen, for the physician operator. Consoles in the system 10 are generally designed to provide both robotic controls as well as preoperative and real-time information of the procedure, such as navigational and localization information of the endoscope 13. When the console 31 is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the health or vitals of the patient and the operation of the system 10, as well as to provide procedure-specific data, such as navigational and localization information. In other embodiments, the console 30 is housed in a body that is separate from the tower 30.

The tower 30 may be coupled to the cart 11 and endoscope 13 through one or more cables or connections (not shown). In some embodiments, the support functionality from the tower 30 may be provided through a single cable to the cart 11, simplifying and de-cluttering the operating room. In other embodiments, specific functionality may be coupled in separate cabling and connections. For example, while power may be provided through a single power cable to the cart 11, the support for controls, optics, fluidics, and/or navigation may be provided through a separate cable.

FIG. 2 provides a detailed illustration of an embodiment of the cart 11 from the cart-based robotically-enabled system shown in FIG. 1. The cart 11 generally includes an elongated support structure 14 (often referred to as a “column”), a cart base 15, and a console 16 at the top of the column 14. The column 14 may include one or more carriages, such as a carriage 17 (alternatively “arm support”) for supporting the deployment of one or more robotic arms 12 (three shown in FIG. 2). The carriage 17 may include individually configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic arms 12 for better positioning relative to the patient. The carriage 17 also includes a carriage interface 19 that allows the carriage 17 to vertically translate along the column 14.

The carriage interface 19 is connected to the column 14 through slots, such as slot 20, that are positioned on opposite sides of the column 14 to guide the vertical translation of the carriage 17. The slot 20 contains a vertical translation interface to position and hold the carriage 17 at various vertical heights relative to the cart base 15. Vertical translation of the carriage 17 allows the cart 11 to adjust the reach of the robotic arms 12 to meet a variety of table heights, patient sizes, and physician preferences. Similarly, the individually configurable arm mounts on the carriage 17 allow the robotic arm base 21 of the robotic arms 12 to be angled in a variety of configurations.

In some embodiments, the slot 20 may be supplemented with slot covers that are flush and parallel to the slot surface to prevent dirt and fluid ingress into the internal chambers of the column 14 and the vertical translation interface as the carriage 17 vertically translates. The slot covers may be deployed through pairs of spring spools positioned near the vertical top and bottom of the slot 20. The covers are coiled within the spools until deployed to extend and retract from their coiled state as the carriage 17 vertically translates up and down. The spring-loading of the spools provides force to retract the cover into a spool when the carriage 17 translates towards the spool, while also maintaining a tight seal when the carriage 17 translates away from the spool. The covers may be connected to the carriage 17 using, for example, brackets in the carriage interface 19 to ensure proper extension and retraction of the cover as the carriage 17 translates.

The column 14 may internally comprise mechanisms, such as gears and motors, that are designed to use a vertically aligned lead screw to translate the carriage 17 in a mechanized fashion in response to control signals generated in response to user inputs, e.g., inputs from the console 16.

The robotic arms 12 may generally comprise robotic arm bases 21 and end effectors 22, separated by a series of linkages 23 that are connected by a series of joints 24, each joint comprising an independent actuator, each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm 12. Each of the robotic arms 12 may have seven joints, and thus provide seven degrees of freedom. A multitude of joints result in a multitude of degrees of freedom, allowing for “redundant” degrees of freedom. Having redundant degrees of freedom allows the robotic arms 12 to position their respective end effectors 22 at a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows for the system to position and direct a medical instrument from a desired point in space while allowing the physician to move the arm joints into a clinically advantageous position away from the patient to create greater access, while avoiding arm collisions.

The cart base 15 balances the weight of the column 14, carriage 17, and robotic arms 12 over the floor. Accordingly, the cart base 15 houses heavier components, such as electronics, motors, power supply, as well as components that either enable movement and/or immobilize the cart 11. For example, the cart base 15 includes rollable wheel-shaped casters 25 that allow for the cart 11 to easily move around the room prior to a procedure. After reaching the appropriate position, the casters 25 may be immobilized using wheel locks to hold the cart 11 in place during the procedure.

Positioned at the vertical end of the column 14, the console 16 allows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as, for example, a touchscreen 26) to provide the physician user with both preoperative and intraoperative data. Potential preoperative data on the touchscreen 26 may include preoperative plans, navigation and mapping data derived from preoperative computerized tomography (CT) scans, and/or notes from preoperative patient interviews. Intraoperative data on display may include optical information provided from the tool, sensor and coordinate information from sensors, as well as vital patient statistics, such as respiration, heart rate, and/or pulse. The console 16 may be positioned and tilted to allow a physician to access the console 16 from the side of the column 14 opposite the carriage 17. From this position, the physician may view the console 16, robotic arms 12, and patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to assist with maneuvering and stabilizing the cart 11.

FIG. 3 illustrates an embodiment of a robotically-enabled system 10 arranged for ureteroscopy. In a ureteroscopic procedure, the cart 11 may be positioned to deliver a ureteroscope 32, a procedure-specific endoscope designed to traverse a patient's urethra and ureter, to the lower abdominal area of the patient. In a ureteroscopy, it may be desirable for the ureteroscope 32 to be directly aligned with the patient's urethra to reduce friction and forces on the sensitive anatomy in the area. As shown, the cart 11 may be aligned at the foot of the table to allow the robotic arms 12 to position the ureteroscope 32 for direct linear access to the patient's urethra. From the foot of the table, the robotic arms 12 may insert the ureteroscope 32 along the virtual rail 33 directly into the patient's lower abdomen through the urethra.

After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscope 32 may be navigated into the bladder, ureters, and/or kidneys for diagnostic and/or therapeutic applications. For example, the ureteroscope 32 may be directed into the ureter and kidneys to break up kidney stone build up using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After lithotripsy is complete, the resulting stone fragments may be removed using baskets deployed down the ureteroscope 32.

FIG. 4 illustrates an embodiment of a robotically-enabled system 10 similarly arranged for a vascular procedure. In a vascular procedure, the system 10 may be configured such that the cart 11 may deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery presents both a larger diameter for navigation as well as a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopic procedure, the cart 11 may be positioned towards the patient's legs and lower abdomen to allow the robotic arms 12 to provide a virtual rail 35 with direct linear access to the femoral artery access point in the patient's thigh/hip region. After insertion into the artery, the medical instrument 34 may be directed and inserted by translating the instrument drivers 28. Alternatively, the cart may be positioned around the patient's upper abdomen in order to reach alternative vascular access points, such as, for example, the carotid and brachial arteries near the shoulder and wrist.

B. Robotic System—Table.

Embodiments of the robotically-enabled medical system may also incorporate the patient's table. Incorporation of the table reduces the amount of capital equipment within the operating room by removing the cart, which allows greater access to the patient. FIG. 5 illustrates an embodiment of such a robotically-enabled system arranged for a bronchoscopic procedure. System 36 includes a support structure or column 37 for supporting platform 38 (shown as a “table” or “bed”) over the floor. Much like in the cart-based systems, the end effectors of the robotic arms 39 of the system 36 comprise instrument drivers 42 that are designed to manipulate an elongated medical instrument, such as a bronchoscope 40 in FIG. 5, through or along a virtual rail 41 formed from the linear alignment of the instrument drivers 42. In practice, a C-arm for providing fluoroscopic imaging may be positioned over the patient's upper abdominal area by placing the emitter and detector around the table 38.

FIG. 6 provides an alternative view of the system 36 without the patient and medical instrument for discussion purposes. As shown, the column 37 may include one or more carriages 43 shown as ring-shaped in the system 36, from which the one or more robotic arms 39 may be based. The carriages 43 may translate along a vertical column interface 44 that runs the length of the column 37 to provide different vantage points from which the robotic arms 39 may be positioned to reach the patient. The carriage(s) 43 may rotate around the column 37 using a mechanical motor positioned within the column 37 to allow the robotic arms 39 to have access to multiples sides of the table 38, such as, for example, both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and/or rotate independently of the other carriages. While the carriages 43 need not surround the column 37 or even be circular, the ring-shape as shown facilitates rotation of the carriages 43 around the column 37 while maintaining structural balance. Rotation and translation of the carriages 43 allows the system 36 to align the medical instruments, such as endoscopes and laparoscopes, into different access points on the patient. In other embodiments (not shown), the system 36 can include a patient table or bed with adjustable arm supports in the form of bars or rails extending alongside it. One or more robotic arms 39 (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be vertically adjusted. By providing vertical adjustment, the robotic arms 39 are advantageously capable of being stowed compactly beneath the patient table or bed, and subsequently raised during a procedure.

The robotic arms 39 may be mounted on the carriages 43 through a set of arm mounts 45 comprising a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms 39. Additionally, the arm mounts 45 may be positioned on the carriages 43 such that, when the carriages 43 are appropriately rotated, the arm mounts 45 may be positioned on either the same side of the table 38 (as shown in FIG. 6), on opposite sides of the table 38 (as shown in FIG. 9), or on adjacent sides of the table 38 (not shown).

The column 37 structurally provides support for the table 38, and a path for vertical translation of the carriages 43. Internally, the column 37 may be equipped with lead screws for guiding vertical translation of the carriages, and motors to mechanize the translation of the carriages 43 based the lead screws. The column 37 may also convey power and control signals to the carriages 43 and the robotic arms 39 mounted thereon.

The table base 46 serves a similar function as the cart base 15 in the cart 11 shown in FIG. 2, housing heavier components to balance the table/bed 38, the column 37, the carriages 43, and the robotic arms 39. The table base 46 may also incorporate rigid casters to provide stability during procedures. Deployed from the bottom of the table base 46, the casters may extend in opposite directions on both sides of the base 46 and retract when the system 36 needs to be moved.

With continued reference to FIG. 6, the system 36 may also include a tower (not shown) that divides the functionality of the system 36 between the table and the tower to reduce the form factor and bulk of the table. As in earlier disclosed embodiments, the tower may provide a variety of support functionalities to the table, such as processing, computing, and control capabilities, power, fluidics, and/or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and de-clutter the operating room. Additionally, placing components in the tower allows for more storage space in the table base 46 for potential stowage of the robotic arms 39. The tower may also include a master controller or console that provides both a user interface for user input, such as keyboard and/or pendant, as well as a display screen (or touchscreen) for preoperative and intraoperative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also contain holders for gas tanks to be used for insufflation.

In some embodiments, a table base may stow and store the robotic arms when not in use. FIG. 7 illustrates a system 47 that stows robotic arms in an embodiment of the table-based system. In the system 47, carriages 48 may be vertically translated into base 49 to stow robotic arms 50, arm mounts 51, and the carriages 48 within the base 49. Base covers 52 may be translated and retracted open to deploy the carriages 48, arm mounts 51, and robotic arms 50 around column 53, and closed to stow to protect them when not in use. The base covers 52 may be sealed with a membrane 54 along the edges of its opening to prevent dirt and fluid ingress when closed.

FIG. 8 illustrates an embodiment of a robotically-enabled table-based system configured for a ureteroscopic procedure. In a ureteroscopy, the table 38 may include a swivel portion 55 for positioning a patient off-angle from the column 37 and table base 46. The swivel portion 55 may rotate or pivot around a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the swivel portion 55 away from the column 37. For example, the pivoting of the swivel portion 55 allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below table 38. By rotating the carriage 35 (not shown) around the column 37, the robotic arms 39 may directly insert a ureteroscope 56 along a virtual rail 57 into the patient's groin area to reach the urethra. In a ureteroscopy, stirrups 58 may also be fixed to the swivel portion 55 of the table 38 to support the position of the patient's legs during the procedure and allow clear access to the patient's groin area.

In a laparoscopic procedure, through small incision(s) in the patient's abdominal wall, minimally invasive instruments may be inserted into the patient's anatomy. In some embodiments, the minimally invasive instruments comprise an elongated rigid member, such as a shaft, which is used to access anatomy within the patient. After inflation of the patient's abdominal cavity, the instruments may be directed to perform surgical or medical tasks, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instruments can comprise a scope, such as a laparoscope. FIG. 9 illustrates an embodiment of a robotically-enabled table-based system configured for a laparoscopic procedure. As shown in FIG. 9, the carriages 43 of the system 36 may be rotated and vertically adjusted to position pairs of the robotic arms 39 on opposite sides of the table 38, such that instrument 59 may be positioned using the arm mounts 45 to be passed through minimal incisions on both sides of the patient to reach his/her abdominal cavity.

To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle. FIG. 10 illustrates an embodiment of the robotically-enabled medical system with pitch or tilt adjustment. As shown in FIG. 10, the system 36 may accommodate tilt of the table 38 to position one portion of the table at a greater distance from the floor than the other. Additionally, the arm mounts 45 may rotate to match the tilt such that the robotic arms 39 maintain the same planar relationship with the table 38. To accommodate steeper angles, the column 37 may also include telescoping portions 60 that allow vertical extension of the column 37 to keep the table 38 from touching the floor or colliding with the table base 46.

FIG. 11 provides a detailed illustration of the interface between the table 38 and the column 37. Pitch rotation mechanism 61 may be configured to alter the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom. The pitch rotation mechanism 61 may be enabled by the positioning of orthogonal axes 1, 2 at the column-table interface, each axis actuated by a separate motor 3, 4 responsive to an electrical pitch angle command. Rotation along one screw 5 would enable tilt adjustments in one axis 1, while rotation along the other screw 6 would enable tilt adjustments along the other axis 2. In some embodiments, a ball joint can be used to alter the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom.

For example, pitch adjustments are particularly useful when trying to position the table in a Trendelenburg position, i.e., position the patient's lower abdomen at a higher position from the floor than the patient's upper abdomen, for lower abdominal surgery. The Trendelenburg position causes the patient's internal organs to slide towards his/her upper abdomen through the force of gravity, clearing out the abdominal cavity for minimally invasive tools to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

FIGS. 12 and 13 illustrate isometric and end views of an alternative embodiment of a table-based surgical robotics system 100. The surgical robotics system 100 includes one or more adjustable arm supports 105 that can be configured to support one or more robotic arms (see, for example, FIG. 14) relative to a table 101. In the illustrated embodiment, a single adjustable arm support 105 is shown, though an additional arm support can be provided on an opposite side of the table 101. The adjustable arm support 105 can be configured so that it can move relative to the table 101 to adjust and/or vary the position of the adjustable arm support 105 and/or any robotic arms mounted thereto relative to the table 101. For example, the adjustable arm support 105 may be adjusted one or more degrees of freedom relative to the table 101. The adjustable arm support 105 provides high versatility to the system 100, including the ability to easily stow the one or more adjustable arm supports 105 and any robotics arms attached thereto beneath the table 101. The adjustable arm support 105 can be elevated from the stowed position to a position below an upper surface of the table 101. In other embodiments, the adjustable arm support 105 can be elevated from the stowed position to a position above an upper surface of the table 101.

The adjustable arm support 105 can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of FIGS. 12 and 13, the arm support 105 is configured with four degrees of freedom, which are illustrated with arrows in FIG. 12. A first degree of freedom allows for adjustment of the adjustable arm support 105 in the z-direction (“Z-lift”). For example, the adjustable arm support 105 can include a carriage 109 configured to move up or down along or relative to a column 102 supporting the table 101. A second degree of freedom can allow the adjustable arm support 105 to tilt. For example, the adjustable arm support 105 can include a rotary joint, which can allow the adjustable arm support 105 to be aligned with the bed in a Trendelenburg position. A third degree of freedom can allow the adjustable arm support 105 to “pivot up,” which can be used to adjust a distance between a side of the table 101 and the adjustable arm support 105. A fourth degree of freedom can permit translation of the adjustable arm support 105 along a longitudinal length of the table.

The surgical robotics system 100 in FIGS. 12 and 13 can comprise a table supported by a column 102 that is mounted to a base 103. The base 103 and the column 102 support the table 101 relative to a support surface. A floor axis 131 and a support axis 133 are shown in FIG. 13.

The adjustable arm support 105 can be mounted to the column 102. In other embodiments, the arm support 105 can be mounted to the table 101 or base 103. The adjustable arm support 105 can include a carriage 109, a bar or rail connector 111 and a bar or rail 107. In some embodiments, one or more robotic arms mounted to the rail 107 can translate and move relative to one another.

The carriage 109 can be attached to the column 102 by a first joint 113, which allows the carriage 109 to move relative to the column 102 (e.g., such as up and down a first or vertical axis 123). The first joint 113 can provide the first degree of freedom (“Z-lift”) to the adjustable arm support 105. The adjustable arm support 105 can include a second joint 115, which provides the second degree of freedom (tilt) for the adjustable arm support 105. The adjustable arm support 105 can include a third joint 117, which can provide the third degree of freedom (“pivot up”) for the adjustable arm support 105. An additional joint 119 (shown in FIG. 13) can be provided that mechanically constrains the third joint 117 to maintain an orientation of the rail 107 as the rail connector 111 is rotated about a third axis 127. The adjustable arm support 105 can include a fourth joint 121, which can provide a fourth degree of freedom (translation) for the adjustable arm support 105 along a fourth axis 129.

FIG. 14 illustrates an end view of the surgical robotics system 140A with two adjustable arm supports 105A, 105B mounted on opposite sides of a table 101. A first robotic arm 142A is attached to the bar or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. The distal end of the first robotic arm 142A includes an instrument drive mechanism 146A that can attach to one or more robotic medical instruments or tools. Similarly, the second robotic arm 142B includes a base 144B attached to the rail 107B. The distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B can be configured to attach to one or more robotic medical instruments or tools.

In some embodiments, one or more of the robotic arms 142A, 142B comprises an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A, 142B can include eight degrees of freedom, including an insertion axis (1-degree of freedom including insertion), a wrist (3-degrees of freedom including wrist pitch, yaw and roll), an elbow (1-degree of freedom including elbow pitch), a shoulder (2-degrees of freedom including shoulder pitch and yaw), and base 144A, 144B (1-degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arm 142A, 142B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

C. Instrument Driver & Interface.

The end effectors of the system's robotic arms may comprise (i) an instrument driver (alternatively referred to as “instrument drive mechanism” or “instrument device manipulator”) that incorporates electro-mechanical means for actuating the medical instrument and (ii) a removable or detachable medical instrument, which may be devoid of any electro-mechanical components, such as motors. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to their intricate mechanical assemblies and sensitive electronics. Accordingly, the medical instruments may be designed to be detached, removed, and interchanged from the instrument driver (and thus the system) for individual sterilization or disposal by the physician or the physician's staff. In contrast, the instrument drivers need not be changed or sterilized, and may be draped for protection.

FIG. 15 illustrates an example instrument driver. Positioned at the distal end of a robotic arm, instrument driver 62 comprises one or more drive units 63 arranged with parallel axes to provide controlled torque to a medical instrument via drive shafts 64. Each drive unit 63 comprises an individual drive shaft 64 for interacting with the instrument, a gear head 65 for converting the motor shaft rotation to a desired torque, a motor 66 for generating the drive torque, an encoder 67 to measure the speed of the motor shaft and provide feedback to the control circuitry, and control circuity 68 for receiving control signals and actuating the drive unit. Each drive unit 63 being independently controlled and motorized, the instrument driver 62 may provide multiple (e.g., four as shown in FIG. 15) independent drive outputs to the medical instrument. In operation, the control circuitry 68 would receive a control signal, transmit a motor signal to the motor 66, compare the resulting motor speed as measured by the encoder 67 with the desired speed, and modulate the motor signal to generate the desired torque.

For procedures that require a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, that sits between the instrument driver and the medical instrument. The chief purpose of the sterile adapter is to transfer angular motion from the drive shafts of the instrument driver to the drive inputs of the instrument while maintaining physical separation, and thus sterility, between the drive shafts and drive inputs. Accordingly, an example sterile adapter may comprise a series of rotational inputs and outputs intended to be mated with the drive shafts of the instrument driver and drive inputs on the instrument. Connected to the sterile adapter, the sterile drape, comprised of a thin, flexible material such as transparent or translucent plastic, is designed to cover the capital equipment, such as the instrument driver, robotic arm, and cart (in a cart-based system) or table (in a table-based system). Use of the drape would allow the capital equipment to be positioned proximate to the patient while still being located in an area not requiring sterilization (i.e., non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area requiring sterilization (i.e., sterile field).

D. Medical Instrument.

FIG. 16 illustrates an example medical instrument with a paired instrument driver. Like other instruments designed for use with a robotic system, medical instrument 70 comprises an elongated shaft 71 (or elongate body) and an instrument base 72. The instrument base 72, also referred to as an “instrument handle” due to its intended design for manual interaction by the physician, may generally comprise rotatable drive inputs 73, e.g., receptacles, pulleys or spools, that are designed to be mated with drive outputs 74 that extend through a drive interface on instrument driver 75 at the distal end of robotic arm 76. When physically connected, latched, and/or coupled, the mated drive inputs 73 of the instrument base 72 may share axes of rotation with the drive outputs 74 in the instrument driver 75 to allow the transfer of torque from the drive outputs 74 to the drive inputs 73. In some embodiments, the drive outputs 74 may comprise splines that are designed to mate with receptacles on the drive inputs 73.

The elongated shaft 71 is designed to be delivered through either an anatomical opening or lumen, e.g., as in endoscopy, or a minimally invasive incision, e.g., as in laparoscopy. The elongated shaft 71 may be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope) or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis with at least one degree of freedom and a surgical tool or medical instrument, such as, for example, a grasper or scissors, that may be actuated based on force from the tendons as the drive inputs rotate in response to torque received from the drive outputs 74 of the instrument driver 75. When designed for endoscopy, the distal end of a flexible elongated shaft may include a steerable or controllable bending section that may be articulated and bent based on torque received from the drive outputs 74 of the instrument driver 75.

Torque from the instrument driver 75 is transmitted down the elongated shaft 71 using tendons along the elongated shaft 71. These individual tendons, such as pull wires, may be individually anchored to individual drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are directed down one or more pull lumens along the elongated shaft 71 and anchored at the distal portion of the elongated shaft 71, or in the wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic or hybrid procedure, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissor. Under such an arrangement, torque exerted on drive inputs 73 would transfer tension to the tendon, thereby causing the end effector to actuate in some way. In some embodiments, during a surgical procedure, the tendon may cause a joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at the distal end of the elongated shaft 71, where tension from the tendon causes the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongated shaft 71 (e.g., at the distal end) via adhesive, control ring, or other mechanical fixation. When fixedly attached to the distal end of a bending section, torque exerted on the drive inputs 73 would be transmitted down the tendons, causing the softer, bending section (sometimes referred to as the articulable section or region) to bend or articulate. Along the non-bending sections, it may be advantageous to spiral or helix the individual pull lumens that direct the individual tendons along (or inside) the walls of the endoscope shaft to balance the radial forces that result from tension in the pull wires. The angle of the spiraling and/or spacing therebetween may be altered or engineered for specific purposes, wherein tighter spiraling exhibits lesser shaft compression under load forces, while lower amounts of spiraling results in greater shaft compression under load forces, but limits bending. On the other end of the spectrum, the pull lumens may be directed parallel to the longitudinal axis of the elongated shaft 71 to allow for controlled articulation in the desired bending or articulable sections.

In endoscopy, the elongated shaft 71 houses a number of components to assist with the robotic procedure. The shaft 71 may comprise a working channel for deploying surgical tools (or medical instruments), irrigation, and/or aspiration to the operative region at the distal end of the shaft 71. The shaft 71 may also accommodate wires and/or optical fibers to transfer signals to/from an optical assembly at the distal tip, which may include an optical camera. The shaft 71 may also accommodate optical fibers to carry light from proximally-located light sources, such as light emitting diodes, to the distal end of the shaft 71.

At the distal end of the instrument 70, the distal tip may also comprise the opening of a working channel for delivering tools for diagnostic and/or therapy, irrigation, and aspiration to an operative site. The distal tip may also include a port for a camera, such as a fiberscope or a digital camera, to capture images of an internal anatomical space. Relatedly, the distal tip may also include ports for light sources for illuminating the anatomical space when using the camera.

In the example of FIG. 16, the drive shaft axes, and thus the drive input axes, are orthogonal to the axis of the elongated shaft 71. This arrangement, however, complicates roll capabilities for the elongated shaft 71. Rolling the elongated shaft 71 along its axis while keeping the drive inputs 73 static results in undesirable tangling of the tendons as they extend off the drive inputs 73 and enter pull lumens within the elongated shaft 71. The resulting entanglement of such tendons may disrupt any control algorithms intended to predict movement of the flexible elongated shaft 71 during an endoscopic procedure.

FIG. 17 illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 comprises four drive units with their drive outputs 81 aligned in parallel at the end of a robotic arm 82. The drive units, and their respective drive outputs 81, are housed in a rotational assembly 83 of the instrument driver 80 that is driven by one of the drive units within the assembly 83. In response to torque provided by the rotational drive unit, the rotational assembly 83 rotates along a circular bearing that connects the rotational assembly 83 to the non-rotational portion 84 of the instrument driver 80. Power and controls signals may be communicated from the non-rotational portion 84 of the instrument driver 80 to the rotational assembly 83 through electrical contacts that may be maintained through rotation by a brushed slip ring connection (not shown). In other embodiments, the rotational assembly 83 may be responsive to a separate drive unit that is integrated into the non-rotatable portion 84, and thus not in parallel to the other drive units. The rotational mechanism 83 allows the instrument driver 80 to rotate the drive units, and their respective drive outputs 81, as a single unit around an instrument driver axis 85.

Like earlier disclosed embodiments, an instrument 86 may comprise an elongated shaft portion 88 and an instrument base 87 (shown with a transparent external skin for discussion purposes) comprising a plurality of drive inputs 89 (such as receptacles, pulleys, and spools) that are configured to receive the drive outputs 81 in the instrument driver 80. Unlike prior disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87 with an axis substantially parallel to the axes of the drive inputs 89, rather than orthogonal as in the design of FIG. 16.

When coupled to the rotational assembly 83 of the instrument driver 80, the medical instrument 86, comprising instrument base 87 and instrument shaft 88, rotates in combination with the rotational assembly 83 about the instrument driver axis 85. Since the instrument shaft 88 is positioned at the center of instrument base 87, the instrument shaft 88 is coaxial with instrument driver axis 85 when attached. Thus, rotation of the rotational assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. Moreover, as the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive inputs 89 in the instrument base 87 are not tangled during rotation. Accordingly, the parallelism of the axes of the drive outputs 81, drive inputs 89, and instrument shaft 88 allows for the shaft rotation without tangling any control tendons.

FIG. 18 illustrates an instrument having an instrument based insertion architecture in accordance with some embodiments. The instrument 150 can be coupled to any of the instrument drivers discussed above. The instrument 150 comprises an elongated shaft 152, an end effector 162 connected to the shaft 152, and a handle 170 coupled to the shaft 152. The elongated shaft 152 comprises a tubular member having a proximal portion 154 and a distal portion 156. The elongated shaft 152 comprises one or more channels or grooves 158 along its outer surface. The grooves 158 are configured to receive one or more wires or cables 180 therethrough. One or more cables 180 thus run along an outer surface of the elongated shaft 152. In other embodiments, cables 180 can also run through the elongated shaft 152. Manipulation of the one or more cables 180 (e.g., via an instrument driver) results in actuation of the end effector 162.

The instrument handle 170, which may also be referred to as an instrument base, may generally comprise an attachment interface 172 having one or more mechanical inputs 174, e.g., receptacles, pulleys or spools, that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument 150 comprises a series of pulleys or cables that enable the elongated shaft 152 to translate relative to the handle 170. In other words, the instrument 150 itself comprises an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing the reliance on a robot arm to provide insertion of the instrument 150. In other embodiments, a robotic arm can be largely responsible for instrument insertion.

E. Controller.

Any of the robotic systems described herein can include an input device or controller for manipulating an instrument attached to a robotic arm. In some embodiments, the controller can be coupled (e.g., communicatively, electronically, electrically, wirelessly and/or mechanically) with an instrument such that manipulation of the controller causes a corresponding manipulation of the instrument e.g., via master slave control.

FIG. 19 is a perspective view of an embodiment of a controller 182. In the present embodiment, the controller 182 comprises a hybrid controller that can have both impedance and admittance control. In other embodiments, the controller 182 can utilize just impedance or passive control. In other embodiments, the controller 182 can utilize just admittance control. By being a hybrid controller, the controller 182 advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 182 is configured to allow manipulation of two medical instruments, and includes two handles 184. Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 is connected to a positioning platform 188.

As shown in FIG. 19, each positioning platform 188 includes a SCARA arm (selective compliance assembly robot arm) 198 coupled to a column 194 by a prismatic joint 196. The prismatic joints 196 are configured to translate along the column 194 (e.g., along rails 197) to allow each of the handles 184 to be translated in the z-direction, providing a first degree of freedom. The SCARA arm 198 is configured to allow motion of the handle 184 in an x-y plane, providing two additional degrees of freedom.

In some embodiments, one or more load cells are positioned in the controller. For example, in some embodiments, a load cell (not shown) is positioned in the body of each of the gimbals 186. By providing a load cell, portions of the controller 182 are capable of operating under admittance control, thereby advantageously reducing the perceived inertia of the controller while in use. In some embodiments, the positioning platform 188 is configured for admittance control, while the gimbal 186 is configured for impedance control. In other embodiments, the gimbal 186 is configured for admittance control, while the positioning platform 188 is configured for impedance control. Accordingly, for some embodiments, the translational or positional degrees of freedom of the positioning platform 188 can rely on admittance control, while the rotational degrees of freedom of the gimbal 186 rely on impedance control.

F. Navigation and Control.

Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide endoluminal guidance to an operator physician. In contrast, the robotic systems contemplated by this disclosure can provide for non-radiation-based navigational and localization means to reduce physician exposure to radiation and reduce the amount of equipment within the operating room. As used herein, the term “localization” may refer to determining and/or monitoring the position of objects in a reference coordinate system. Technologies such as preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to achieve a radiation-free operating environment. In other cases, where radiation-based imaging modalities are still used, the preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to improve upon the information obtained solely through radiation-based imaging modalities.

FIG. 20 is a block diagram illustrating a localization system 90 that estimates a location of one or more elements of the robotic system, such as the location of the instrument, in accordance to an example embodiment. The localization system 90 may be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices may be in the tower 30 shown in FIG. 1, the cart 11 shown in FIGS. 1-4, the beds shown in FIGS. 5-14, etc.

As shown in FIG. 20, the localization system 90 may include a localization module 95 that processes input data 91-94 to generate location data 96 for the distal tip of a medical instrument. The location data 96 may be data or logic that represents a location and/or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference can be a frame of reference relative to the anatomy of the patient or to a known object, such as an EM field generator (see discussion below for the EM field generator).

The various input data 91-94 are now described in greater detail. Preoperative mapping may be accomplished through the use of the collection of low dose CT scans. Preoperative CT scans are reconstructed into three-dimensional images, which are visualized, e.g. as “slices” of a cutaway view of the patient's internal anatomy. When analyzed in the aggregate, image-based models for anatomical cavities, spaces and structures of the patient's anatomy, such as a patient lung network, may be generated. Techniques such as center-line geometry may be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomy, referred to as model data 91 (also referred to as “preoperative model data” when generated using only preoperative CT scans). The use of center-line geometry is discussed in U.S. patent application Ser. No. 14/523,760, the contents of which are herein incorporated in its entirety. Network topological models may also be derived from the CT-images, and are particularly appropriate for bronchoscopy.

In some embodiments, the instrument may be equipped with a camera to provide vision data (or image data) 92. The localization module 95 may process the vision data 92 to enable one or more vision-based (or image-based) location tracking modules or features. For example, the preoperative model data 91 may be used in conjunction with the vision data 92 to enable computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advance through a working channel of the endoscope). For example, using the preoperative model data 91, the robotic system may generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. Intraoperatively, this library may be referenced by the robotic system in order to compare real-time images captured at the camera (e.g., a camera at a distal end of the endoscope) to those in the image library to assist localization.

Other computer vision-based tracking techniques use feature tracking to determine motion of the camera, and thus the endoscope. Some features of the localization module 95 may identify circular geometries in the preoperative model data 91 that correspond to anatomical lumens and track the change of those geometries to determine which anatomical lumen was selected, as well as the relative rotational and/or translational motion of the camera. Use of a topological map may further enhance vision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze the displacement and translation of image pixels in a video sequence in the vision data 92 to infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated encoding, stereo disparity measurement, etc. Through the comparison of multiple frames over multiple iterations, movement and location of the camera (and thus the endoscope) may be determined.

The localization module 95 may use real-time EM tracking to generate a real-time location of the endoscope in a global coordinate system that may be registered to the patient's anatomy, represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils embedded in one or more locations and orientations in a medical instrument (e.g., an endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a known location. The location information detected by the EM sensors is stored as EM data 93. The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be intraoperatively “registered” to the patient anatomy (e.g., the preoperative model) in order to determine the geometric transformation that aligns a single location in the coordinate system with a position in the preoperative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more positions of the medical instrument (e.g., the distal tip of an endoscope) may provide real-time indications of the progression of the medical instrument through the patient's anatomy.

Robotic command and kinematics data 94 may also be used by the localization module 95 to provide localization data 96 for the robotic system. Device pitch and yaw resulting from articulation commands may be determined during preoperative calibration. Intraoperatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and/or topological modeling to estimate the position of the medical instrument within the network.

As FIG. 20 shows, a number of other input data can be used by the localization module 95. For example, although not shown in FIG. 20, an instrument utilizing shape-sensing fiber can provide shape data that the localization module 95 can use to determine the location and shape of the instrument.

The localization module 95 may use the input data 91-94 in combination(s). In some cases, such a combination may use a probabilistic approach where the localization module 95 assigns a confidence weight to the location determined from each of the input data 91-94. Thus, where the EM data may not be reliable (as may be the case where there is EM interference) the confidence of the location determined by the EM data 93 can be decrease and the localization module 95 may rely more heavily on the vision data 92 and/or the robotic command and kinematics data 94.

As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the technologies above. The robotic system's computer-based control system, based in the tower, bed and/or cart, may store computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, or the like, that, upon execution, cause the system to receive and analyze sensor data and user commands, generate control signals throughout the system, and display the navigational and localization data, such as the position of the instrument within the global coordinate system, anatomical map, etc.

2. Robotic Arm Alignment and Docking.

Embodiments of the disclosure relate to systems and techniques for computer assisted alignment and/or docking of robotic arm(s) to a target associated with a patient. In certain arrangements, prior to introducing a surgical instrument into a patient, a robotic arm may be aligned and/or docked with a target (e.g., a port or cannula which is installed or otherwise placed in the patient). After docking, the robotic arm and/or system may be configured to control the movement of a distal end of an instrument.

In theory, the docking process seems simple. However, it can be a very challenging and finicky process. For example, in an attempt to dock a robotic arm to a cannula, a clinician may encounter arms, drapes, and other surgical equipment, which can make it a challenge to dock the robotic arm. Furthermore, docking can be time consuming, and can involve numerous adjustments and interactions with a draped robotic system in a confined space. Due to the time consuming nature, surgeons may often choose sub-optimal port locations that will accommodate larger workspaces in the event that a procedure demands them. In addition, the alignment between the robotic arm and the cannula can be very fine and difficult to accomplish.

The present application describes novel docking methods that help to at least partially automate the docking process. Furthermore, this application appreciates that in some instances, automated docking processes can involve their own challenges. For example, consider an automated process in which a robotic arm is designed to automatically detect (e.g., via a vision sensor or camera), move and latch to a cannula. It is possible that in some instances, the vision sensor may detect a false positive. In other instances, a desired cannula may be obstructed from the view of the vision sensor.

The present application describes methods that improve on automated docking processes and alleviates the challenges described above. In some embodiments, a novel docking process is provided that utilizes both an automatic mode and a manual mode. In one embodiment, the automatic mode utilizes a first sensor (e.g., a vision sensor) to capture images and direct automatic movement of the robotic arm, while the manual mode utilizes a second sensor (e.g., a non-vision based sensor) that allows for guided manual movement by a clinician. Embodiments of robotic arms utilizing the first and second types of sensors are described in more detail below.

FIGS. 21A-21C is an example embodiment of an active device manipulator (ADM) 205 including one or more sensors in accordance with aspects of this disclosure. The ADM 205, illustrated in FIGS. 21A-21C, can be used in the methods described herein. The ADM 205 can be similar to earlier disclosed embodiments, such as the instrument driver 80 as described above. The ADM 205 can be similarly comprised of a plurality of drive units that can be coupled to an instrument to manipulate and control the instrument, as described previously. In certain arrangements, it is desirable to dock and/or couple the ADM (e.g., instrument driver 80) to a port or cannula which is installed or otherwise placed in the patient.

As shown in FIG. 21A, the robotic arm 12 can include the ADM 205 at a distal end. As shown in FIG. 21B, a first sensor 225 can be installed on a portion of the ADM 205 so as to capture images or be used to direct automatic movement of the robotic arm 12 or the ADM 205. The first sensor 225 can be an image sensor or a vision based sensor, such as a camera. In certain arrangements, the first sensor 225 can be a non-vision based sensor, such as a switch, force sensor, or torque sensor. In the illustrated embodiment as shown in FIG. 21B, the first sensor 225 can be recessed in the body of the ADM 205. As shown in the illustrated embodiment in FIG. 21B, the first sensor 225 can be positioned on one side of the ADM 205, which can be considered the front end, or the end that mates and/or faces a cannula. In other embodiments, the first sensor 225 can be attached (permanently or detachably) to an outer surface of the ADM 205, integrated with the ADM 205, or otherwise found within the body of the ADM 205. The first sensor 225 can also be mounted in other locations, such as on the robot arm 12, on instruments, or at other locations within the operating room. The first sensor 225 can be used to detect the relative spatial position of a various components of the system, such as the port or cannula 205, when the system is in an automatic mode during various steps of aligning and/or positioning the robotic arm 12 and ADM 205.

A second sensor 220 can be installed on a portion of the ADM 205, as shown in FIG. 21C. The second sensor 220 can be used to guide manual movement of the robotic arm 12 and/or the ADM 205. The second sensor 220 can be a different from the first sensor. In one embodiment, the second sensor 220 is a non-vision based sensor, such as a switch, force sensor, or torque sensor. In other embodiments, the second sensor 220 can also be a vision based sensor, such as a camera. In some embodiments, the second sensor 220 can be incorporated as an input to guide manual movement of the robotic arm 12 (e.g., during an admittance mode). For example, the ADM 205 can have a designated grab point 215 for a user, such as a physician, to touch or grab the ADM 205 to activate or switch modes, such as the manual or admittance mode, an impedance mode, or a gravity balancing mode. The grab point 215 can include the second sensor 220, which can be a non-vision based sensor such as a load cell or button. In some embodiments, the second sensor 220 can be a displacement sensor, such as an optical proximity sensor or a hall effect sensor. The use of a designated grab point 215 can ensure the user's intention is communicated to the system to enter the particular mode, such as the manual mode. In some embodiments, the use of the designated grab point 215 can also ensure the user's and patient's safety, as the system can be designed such that the manual mode can only be activated if the user touches the grab point 215.

In the illustrated embodiment as shown in FIG. 21C, the second sensor 220 can be at least partially recessed in the body of the ADM 205. In other embodiments, the second sensor 220 can be attached to an outer surface of the ADM 205 or can be positioned elsewhere in the system, such as on the robotic arm 12. As shown in the illustrated embodiment in FIG. 21C, the second sensor 220 can be positioned on one side of the ADM 205, which can be considered the back end of the ADM 205. In other embodiments, the second sensor 220 can be attached (permanently or detachably) to an outer surface of the ADM 205, integrated with the ADM 205, or otherwise found within the body of the ADM 205. The second sensor 220 can also be mounted on the robot arm 12, on the ADM 205, on instruments, or at other locations within the operating room. The sensors, such as the first sensor 225 and the second sensor 220, can be positioned in various positions on the ADM 205, on instruments, or at other locations within the operating room.

The first sensor 225 and second sensor 220 can be used for different modes of user control, such as automatic mode and manual mode respectively. Similarly, other modes of user control including differing levels of automation can also be employed. However, other sensor types can be used. Example sensors which can be used to determine the relative position of the ADM 205 and the cannula include an EM sensor, an IR sensor, a LIDAR sensor, and/or an RF sensor.

Aspects of this disclosure involve the use of one or more sensors to assist in alignment and docking of a robotic arm 12 with a target associated with a patient. The docking procedure can involve moving the robotic arm 12 or ADM 205 to align a first axis associated with the robotic arm 12 or ADM 205 into alignment with a second axis associated with the target, such as a cannula positioned within a patient. In some embodiments, the docking procedure can involve aligning and docking of an ADM 205/robotic arm 12 with a point in space, rather than an axis. For example, the docking procedure can involve aligning and docking of an ADM 205 with a port. Although the procedure described herein can involve the docking of the robotic arm 12 or ADM 205 with a port or cannula, in other embodiments, the robotic arm 12 can instead be aligned with an access point of the patient, where the access point does not include a port placed or installed in the patient (e.g., a natural orifice such as the patient's sinus).

In some embodiments, the alignment and docking process can be fully automated or fully manual. In some embodiments, the alignment and docking process can be a combination of automatic and manual modes. The docking method can combine the use of automatic and manual modes with the use of various sensors of the system. The use of automatic movement can be advantageous to improve ease of use and provide superior accuracy and precision. The use of manual mode can be advantageous in being more reliable, being immediately responsive, avoiding collision, and avoiding injury to the patient. The use of both types of modes allows the docking method to be both precise and reliable, all while maintaining patient safety and ease of use.

FIGS. 22-24 illustrate various stages of an exemplary docking method in accordance with aspects of this disclosure. This docking method can be implemented after initial deployment of the robotic arms in pre-surgery preparation or during surgery when robotic arms need to be re-docked. During initial deployment, the ADM 205 can be deployed to locations where the ADM 205 is already approximately aiming the cannula 235. Advantageously, the docking method described herein can utilize both automatic and/or manual modes or features to accurately dock an ADM to a cannula.

With reference to FIGS. 22-24, the system according to one embodiment includes the ADM 205, the first sensor 225 comprising an image sensor with an associated field of view 230, a port or cannula 235, a fiducial 240, and a body wall 245 of a patient. The ADM 205 is attached to the distal end of a robotic arm (not illustrated) configured to control movement of the ADM 205 and an instrument. FIG. 22 illustrates an ADM 205 and a cannula 235 positioned within a patient 245. The system can also include a first sensor 225 and a second sensor 220, similar to FIGS. 21A-21C. As shown in FIGS. 22-24, the sensors including the first sensor 225 and second sensor 220 are positioned in different locations than in FIGS. 21A-C. For example, in FIGS. 22-24, the first sensor 225 may be positioned on a front end of the ADM 205 to face the cannula 235. The second sensor 220 may be positioned on the back end of the ADM 205, opposite the front end. For certain procedures, a sterile drape (not illustrated) can be coupled to the ADM 205 to provide a barrier between the ADM 205 and the patient 245. The sterile drape can cover at least a portion of the ADM 205 including the one or more sensors. Since in some instances, the sterile drape can be opaque, the sterile drape can include a transparent region that overlaps with the one or more sensors such that the first sensor 225 can view or detect the cannula 235 via the transparent region. Thus, the transparent region can be configured so that the field of view 230 is substantially unobstructed by the sterile drape.

As shown in FIG. 22, the cannula 235 is positioned within the field of view 230 of the first sensor 225. The ADM 205 can be positioned such that the cannula 235 is within the field of view 230 of the first sensor 225, such that the first sensor 225 can detect the cannula 235. The robotic arm (not illustrated) or ADM 205 can be translated towards a cannula 235 positioned within a patient 245. This step can be performed in an automatic mode or manual mode. The ADM 205 can be translated towards the cannula 235 and positioned near the cannula 235 such that the cannula 235 is positioned within the range or field of view 230 of the first sensor 225. The robotic arm and ADM 205 can be located at a distance from the cannula 235 and the ADM 205 can be misaligned with the cannula 235. However, at the end of this step, the cannula 235 should roughly face the first sensor 225 of the ADM 205. The ADM 205 can be roughly deployed to a location that is aimed at a desired cannula 235.

In another embodiment, the movement of the ADM 205 and/or the cannula 235 to achieve the desired position of FIG. 22 can be performed manually by a user. In the manual mode, the user can manually hold the cannula 235 and orient the face of the cannula 235 (which can include a fiducial 240) to approximately face the first sensor 225 of the ADM 205. The user can manually position the ADM 205 into the first position such that the fiducial 240 is within the field of view 230 of the first sensor 225. To ensure that the first sensor 225 can pick up on a fiducial 240 attached to the cannula 235, the user can move the ADM 205 or robotic arm using a second sensor 220 (as described in FIG. 21C). For example, in an embodiment in which the ADM 205 incorporates a non-vision based sensor, such as a force sensor (e.g., a load cell), the user can contact and move the ADM 205 by applying force on the ADM 205. As described in FIG. 21B, the user can touch or apply force to the grab point 215 of the ADM 205. In some embodiments, if a cannula 235 is not detected for some reason, the ADM 205 can go through a scanning procedure in an attempt to detect the cannula 235. This scan procedure can involve reorienting the ADM 205 in a range of directions until the cannula 235 is detected. The system can include an indicator (not shown) that indicates whether the cannula is within the field of view or if the cannula has been detected. The indicator can be positioned on the ADM 205 or in other parts of the system. The manual mode can be executed with the use of the one or more sensors associated with the ADM 205, such as the first sensor 225 or the second sensor 220 as described in FIGS. 21B-21C.

In another embodiment, the movement of the ADM 205 can be performed automatically by the system. In the automatic mode, the ADM 205 can scan the field of view 230 to detect the cannula 235. This scan process can include reorienting the ADM 205 in a range or direction to detect the cannula 235. Additionally, the user can manually move the ADM 205 to be within range for the ADM 205 to enable proper aiming or scanning in the automatic mode. In the automatic mode, the system can be able to use the data received from the first sensor 225 to determine the relative position between the ADM 205 and the cannula 235. The system can then use the sensor data to move and position the ADM 205 such that the first sensor 225 roughly faces the cannula 235. The automatic mode can be executed with the use of the one or more sensors associated with the ADM 205, such as the first sensor 225 or the second sensor 220 as described in FIGS. 21B-21C.

The ADM 205 can also be positioned such that the first sensor 225 roughly faces the end of the cannula 235, which can include a fiducial 240. Aspects of this disclosure also relate to the user of other sensor types, which can involve the use of different fiducials. The first sensor 225 can be used to detect and identify a fiducial 240 that is associated with the cannula 235 or access point. As used herein, a fiducial can refer to a marking or object that can be detected by the sensor and used by the system to determine the relative spatial position between the fiducial 240 and the first sensor 225. For example, when the first sensor 225 is embodied as an image sensor, the fiducial 240 can include a marking or other visual pattern detectable by the image sensor. In the EM sensor embodiments, the fiducial 240 can include an EM emitter and/or reflector that radiates an EM signal detectable by the EM sensor. The processor can be configured to determine the orientation and position of the fiducial 240 relative to the first sensor 225 based on a signal produced by the first sensor 225. In certain embodiments, the fiducial 240 can be positioned on the patient 245 in a defined relative position with an access point in which the cannula 235 is located. Likewise, fiducials need not be placed on the cannula 235 itself. For example, fiducials can be placed on the patient and/or on a draping in a known relative spatial position and orientation with respect relation to the cannula 235.

When the fiducial 240 is within the field of view 230 of the first sensor 225, the system can use the data received from the first sensor 225 to determine the relative position between the ADM 205 and the cannula 235. If this first sensor 225 is an image sensor, the first sensor 225 can collect images that can be used to determine the relative position of the cannula 235.

Referring now to FIG. 23, the ADM 205 can then be moved towards the cannula 235. The ADM 205 can be positioned such that it is oriented or aligned with the cannula such that the axis of the ADM 205 is aligned with the axis of the cannula 235. This step may be performed in an automatic mode or manual mode. The ADM 205 may move or translate to a location close to the cannula 235, such that the ADM 205 and cannula 235 are aligned for docking along the same axis 210. In addition to ensuring proper orientation and alignment between the ADM 205 and the cannula 235, the ADM 205 may translate to a location close to the cannula 235.

Using the data received from the first sensor 225 or second sensor 220 as an input, the processor may provide instructions to the robotic arm (not illustrated) to move the ADM 205 from the first position in FIG. 22 to the second position illustrated in FIG. 23. In the position illustrated in FIG. 23, the ADM 205 axis is substantially aligned with the insertion axis of the cannula 235, such that they aligned along the same axis 210. The processor may be able to determine both the relative location and orientation of the fiducial 240 relative to the ADM 205 based on the data received from the first sensor 225 or the second sensor 220. The processor may also use data indicative of the relative location of the fiducial 240 with respect to the cannula 235 and the relative location of the first sensor 225 with respect to the ADM 205 to determine the relative location of the fiducial 240 with respect to the ADM 205.

It can be advantageous to perform the step of aligning the ADM 205 with the cannula 235 along the same axis 210 in an automatic mode. The automatic mode may align the ADM 205 with the cannula 235 to a more accurate or precise degree. The alignment in automatic mode can also avoid the human error that can occur than if alignment was performed in manual mode.

As shown in FIG. 24, the ADM 205 may be docked onto the cannula 235. This step may be performed in an automatic mode or manual mode. This final step of docking may be done in manual mode by the user to ensure patient safety. Additionally, there are benefits to having the final docking be performed with the support of one or more sensors used in the manual mode or automatic mode.

For example, if a user was to rely entirely on the automatic mode, there are times when the ADM 205 might miss the cannula 235 and can cause injury to the patient 245. Rather than automating the final docking process, once the ADM 205 is automatically brought close enough to the cannula 235, a user can then use a non-vision based sensor to manually dock the ADM 205 to the cannula 235. In some embodiments, the ADM 205 can be constrained to stay in a straight line along the same axis 210 as it is being docked to a cannula 235. When the ADM 205 is docked onto the cannula 235, an instrument (not illustrated) may be inserted and retracted through the ADM 205 into the cannula 235 and into the patient 245.

It can be advantageous to perform the step of docking the ADM 205 onto the cannula 235 in a manual mode. Performing the docking in a manual mode may ensure patient safety to avoid injury to the patient. The docking in manual mode can also avoid the risk and danger of computer error that can occur than if alignment was performed in automatic mode.

The various steps of docking methods as described herein can each be performed in automatic or manual mode or a combination of modes. There can additionally be a combination of modes used. For example, the ADM 205 may automatically move to continue to aim toward the cannula, even if the user is manually moving the ADM 205 or the cannula 235.

The automatic mode or manual mode can be activated by various methods, including activating a switch, a pedal, a button, a force sensor, or a torque sensor. Switching the robotic surgery system to the manual mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell. Switching to a particular mode may require a activating a particular method, such as a particular foot pedal. While activating another mode may require activating a different method, such as a different foot pedal or activating a touch sensor. Alternatively, switching from one mode to another mode can be automatic if the user keeps activating the same means to activate the previous mode. In some embodiments, the alignment and docking process can be performed while a button is pressed in a certain mode (e.g., and pause if the button is released).

By providing a smooth transition between the different types of docking modes, a user will be provided with the best experience. This can be achieved in several ways. For example, when mode switching is desired, the robot can first come to a smooth stop, switch to a different docking mode, then start accelerating smoothly. In transitioning between modes, online motion planning can be used to smooth the transition between manual to automatic modes or vice versa. The smooth transition can be achieved algorithmically without requiring a stop e.g., using online motion planning.

Either automatic mode or manual mode docking can be deactivated at any time, such that the robot will stop after that. This can be achieved, for example, by depressing a button or foot peddle used for activating a corresponding docking mode. This is to ensure that the system is safe in case anything unexpected happens. Automatic mode can be overridden by manual mode docking. If automatic mode docking is behaving undesirably, the user can switch to manual mode docking by pressing another button or simply pull hard on the ADM if a force sensor or load cell is used. This may be achieved by force thresholding.

FIG. 25 is a flowchart illustrating an example method operable by a surgical robotic system, or component(s) thereof, for aligning a robotic arm or ADM with a cannula in accordance with aspects of this disclosure. Although the procedure described in connection with FIG. 25 may involve the docking of the ADM with a cannula, in other embodiments, the ADM may instead be aligned with an access point of the patient, where the access point does not include a port placed or installed in the patient (e.g., a natural orifice such as the patient's sinus). In certain embodiments, the system may include a user input (e.g., a button or switch) configured to control the alignment/docking process.

The steps of method 300 illustrated in FIG. 25 can be performed by a processor of a surgical robotic system. For convenience, the method 300 is described as performed by the processor of the system. The processor can be included as a part of a system, including a robotic arm (e.g., the robotic arm(s) 12 of FIGS. 1-4) and one or more sensors configured to generate information indicative of a location of the robotic arm. In some embodiments, the one or more sensors can include a vision-based sensor, such as an image sensor (e.g., a camera) that can be attached to the robotic arm or attached at an ADM located at a distal end of the robotic arm. The one or more sensors can also include a non-vision based sensor, such as a force sensor that can be attached to the robotic arm or attached to the ADM.

However, in other embodiments, any other type of sensor (e.g., an EM sensor, an infrared (IR) sensor, a Light Detection and Ranging (LIDAR) sensor, and/or a radio frequency (RF) sensor) can be used. In alternative embodiments, the one or more sensors can be positioned in other locations within the operating environment other than at the ADM. For example, the sensor can be mounted to a bed or cart or can be mounted to another robotic arm other than the robotic arm currently being docked.

Referring back to FIG. 25, the method 300 begins at block 302. At block 302, the processor translates the robotic arm and drive mechanism or ADM 205 towards the cannula 235 in an automatic mode. This step can generally correspond to the positions and steps described with reference to FIG. 22 or FIG. 23. In this step, the robotic arm or ADM 205 can be positioned such that the cannula 235 is within the first sensor's 225 field of view or range, as described in FIG. 22. Additionally, automatically translating the robotic arm with the drive mechanism 205 towards the cannula 235 positioned at least partially within the patient can include aligning the drive mechanism 205 with the cannula 235 as described in FIG. 23. This step can also utilize a vision-based sensor, such as the first sensor 225, positioned on the robotic arm or the drive mechanism 205 to aid the automatic movement of the ADM 205 or robotic arm.

In the automatic mode, the processor receives information indicative of a location of the robotic arm or ADM 205 from one or more sensors, such as the first sensor 225 as described previously. The information can define the relative spatial position of the ADM 205 with respect to the cannula 235, which can include a fiducial 240. Since the fiducial 240 can be located at a predetermined relative position with respect to the cannula 235, the processor can be able to determine the relative positions of the ADM 205 and the cannula 235.

The processor can determine that the cannula 235 is within the field of view of the ADM' s 205 one or more sensors, such as the first sensor 225 and second sensor 220. If the processor determines that the cannula 235 is not within the field of view, the processor can activate a scanning process in which the ADM 205 scans the area to determine the location of the cannula 235. The scanning process can involve moving the ADM 205 to a different location or different angle and scanning the area to identify the location of the cannula 235.

Once the process determines the cannula 235 is within the field of the ADM's 205 one or more sensors, including the first sensor 225 and second sensor 220. the processor can then move the ADM 205 to a desired location relative to the cannula 235 in the automatic mode, with the use of the one or more sensors. The processor can determine that the ADM 205 is located at a first position in which a first axis associated with the ADM 205 is not in alignment with a second axis associated with a cannula 235 installed in a patient. Here, the first axis can comprise an axis along which an instrument is configured to be inserted/retracted by the robotic arm and ADM 205, and the second axis can comprise an insertion axis of the ADM 205 through which the instrument can be inserted. The processor provides a command to translate the robotic arm and ADM 205 towards the cannula 235.

In some embodiments, the ADM 205 can be translated to a position in which axis of the ADM 205 is in alignment with the insertion axis of the cannula 235. Accordingly, the processor can to determine the motion of the robotic arm or ADM 205 which will bring the robotic arm or ADM 205 into alignment with the cannula 235.

At block 304, the processor switches the system to a manual mode. Switching the robotic surgery system to the manual mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell. This switching can be implemented by a user activating such a sensor, such as the second sensor 220 as described above. In the manual mode, the processor receives information indicative of a location of the amount of force or direction of force the user has applied to the second sensor 220. The information can define the direction or distance the user wishes to translate the ADM 205. The processor can then allow the user to move the ADM 205 or for the ADM 205 to move in the desired direction or distance.

At block 306, the drive mechanism 205 is translated towards the cannula in the manual mode. The ADM 205 can move or translate to a location close to the cannula 235, where the ADM 205 and cannula 235 are aligned for docking along the same axis. The ADM may 205 can translate to a location close to the cannula 235, as described in FIG. 23. In some embodiments, the ADM 205 can be constrained to stay in a straight line along the same axis or constrained to move along the axis as the ADM 205 is being docked to the cannula 235. This step can also utilize a non-vision based sensor, such as the second sensor 220, positioned on the robotic arm or the drive mechanism 205 to aid the manual movement of the ADM 205 or robotic arm.

With the axis of the ADM 205 aligned with the axis of the cannula 235, the processor can allow the user to manually move the ADM 205 towards the cannula 235 along the aligned insertion axis. The processor can allow the user to manually move the ADM 205 within a threshold distance of the cannula 235 to allow the ADM 205 to be docked to the cannula 235.

At block 308, the drive mechanism 205 is docked onto the cannula 235 in the manual mode. This step can be executed similar to the positions and method described in FIG. 24. This final step of docking can be done in manual mode to ensure patient safety. Rather than automating the final docking process, once the ADM 205 is automatically brought close enough to the cannula 235 at block 306, a user can then use a non-vision based sensor, such as the second sensor 220, to manually dock the ADM 205 to the cannula 235. In some embodiments, the ADM 205 can be constrained to stay in a straight line along the same axis as it is being docked to a cannula 235. When the ADM 205 is docked onto the cannula 235, an instrument (not illustrated) can be inserted and retracted through the ADM 205 into the cannula 235 and into the patient. In certain embodiments, the final docking (e.g., coupling or latching) of the ADM 205 to the cannula 235 can be performed manually. The processor can allow the user to manually move the ADM 205 onto the cannula 235.

FIG. 26 illustrates another method 400 that can be performed by a processor of a surgical robotic system. For convenience, the method 400 is described as performed by the processor of the system. The processor can be included as a part of a system, including a robotic arm (e.g., the robotic arm(s) 12 of FIGS. 1-4) and one or more sensors configured to generate information indicative of a location of the robotic arm. In some embodiments, the one or more sensors can include a vision-based sensor, such as an image sensor (e.g., a camera) that can be attached to the robotic arm or attached at an ADM located at a distal end of the robotic arm. The one or more sensors can also include a non-vision based sensor, such as a force sensor that can be attached to the robotic arm or attached to the ADM.

The method 400 can begin at block 402. At block 402, the processor allows the user to translate the robotic arm and drive mechanism 205 towards the cannula 235 in a manual mode. This step can generally correspond to the positions and method described with reference to FIG. 22. In this step, the processor can allow the user to translate the robotic arm and ADM 205 such towards the cannula 235, such that the cannula 235 is within the first sensor's 225 field of view or range, as described in FIG. 22. This step can also utilize a non-vision based sensor, such as the second sensor 220, positioned on the robotic arm or the ADM 205 to aid the manual movement of the ADM 205 or robotic arm.

At block 404, the processor switches the system to an automatic mode. Switching the robotic surgery system to the automatic mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell. As described herein, in the automatic mode, the processor receives information indicative of a location of the robotic arm or ADM 205 from one or more sensors, such as from the first sensor 225.

At block 406, the processor can translate or orient the drive mechanism 205 towards the cannula 235 in the automatic mode. The processor can determine that the cannula 235 is within the field of view of the ADM's 205 one or more sensors, such as the first sensor 225. Once the process determines the cannula 235 is within the field of the ADM's 205 one or more sensors, the processor can then move the ADM 205 to a desired location relative to the cannula 235 in the automatic mode, with the use of the one or more sensors, such as the first sensor 225. The processor can determine that the ADM 205 is located at a first position in which a first axis associated with the ADM 205 is not in alignment with a second axis associated with a cannula 235 installed in a patient. Here, the first axis can comprise an axis along which an instrument is configured to be inserted/retracted by the robotic arm and ADM 205, and the second axis can comprise an insertion axis of the ADM 205 through which the instrument can be inserted. The processor provides a command to translate the robotic arm and ADM 205 towards the cannula 235. In some embodiments, the ADM 205 can translate the ADM 205 and robotic arm to a position in which axis of the ADM 205 is in alignment with the insertion axis of the cannula 235. Accordingly, the processor can determine the motion of the robotic arm which will bring the robotic arm into alignment with the cannula 235.

Additionally, the processor can also translate the drive mechanism towards the cannula 235 in automatic mode. The ADM 205 can move or translate to a location close to the cannula 235, where the ADM 205 and cannula 235 are aligned for docking along the same axis. The ADM 205 can translate to a location close to the cannula 235, as described in FIG. 23. In some embodiments, the ADM 205 can be constrained to stay in a straight line along the same axis or constrained to move along the axis as the ADM 205 is being docked to the cannula 235. This step can also utilize a non-vision based sensor, such as the second sensor 220, positioned on the robotic arm or the ADM 205 to aid the automatic movement of the ADM 205 or robotic arm. With the axis of the ADM 205 aligned with the axis of the cannula 235, the processor can translate the ADM 205 towards the cannula 235 along the aligned insertion axis. The processor can automatically move the ADM 205 within a threshold distance of the cannula 235 to allow the ADM 205 to be docked to the cannula 235.

At block 408, the processor switches the system to a manual mode. Similar to block 404, switching the robotic surgery system to the manual mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell.

At block 410, the drive mechanism 205 is docked onto the cannula 235 in the manual mode. This step can be executed similar to the positions and method described in FIG. 24. This final step of docking can be done in manual mode to ensure patient safety. Rather than automating the final docking process, once the ADM 205 is automatically brought close enough to the cannula 235 at block 406, a user can then use a non-vision based sensor, such as the second sensor 220, to manually dock the ADM 205 to the cannula 235. In some embodiments, the ADM 205 can be constrained to stay in a straight line along the same axis as it is being docked to a cannula 235. When the ADM 205 is docked onto the cannula 235, an instrument (not illustrated) can be inserted and retracted through the ADM 205 into the cannula 235 and into the patient. In certain embodiments, the final docking (e.g., coupling or latching) of the ADM 205 to the cannula 235 can be performed manually. The processor can allow the user to manually move the ADM 205 onto the cannula 235.

FIG. 27 illustrates another method 500 that can be performed by a processor of a surgical robotic system. For convenience, the method 500 is described as performed by the processor of the system. The processor can be included as a part of a system, including a robotic arm (e.g., the robotic arm(s) 12 of FIGS. 1-4) and one or more sensors configured to generate information indicative of a location of the robotic arm. In some embodiments, the one or more sensors can include a vision-based sensor, such as an image sensor (e.g., a camera) that can be attached to the robotic arm or attached at an ADM located at a distal end of the robotic arm. The one or more sensors can also include a non-vision based sensor, such as a force sensor that can be attached to the robotic arm or attached to the ADM. The vision-based sensor can be used to align the ADM with the cannula or remote center of the cannula. The non-vision based sensor can be used in the manual mode to translate the ADM towards the cannula.

The method 500 can begin at block 502. At block 502, the processor allows the user to translate the robotic arm and drive mechanism 205 towards the cannula 235 in an automatic or manual mode. This step can generally correspond to the positions and methods described with reference to FIGS. 22 and 23. This step can utilize a non-vision based sensor in the manual mode, such as the second sensor 220, positioned on the robotic arm or the ADM 205 to aid the manual movement of the ADM 205 or robotic arm. The processor can allow the user to translate the robotic arm or the ADM 205 such towards the cannula 235, such that the cannula 235 is within the first sensor's 225 field of view or range. This step can also utilize a vision based sensor in the automatic mode, such as the first sensor 225, positioned on the robotic arm or the drive mechanism 205 to aid the automatic movement of the ADM 205 or robotic arm. The processor can automatically translate the robotic arm with the drive mechanism 205 towards the cannula 235 positioned at least partially within the patient can include aligning the drive mechanism 205 with the cannula 235.

At block 504, the processor switches the system to a hybrid mode. Switching the robotic surgery system to the hybrid mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell, as described previously. The processor can receive the signal communicated from the user and the processor can switch to the hybrid mode.

At block 506, the processor can translate the drive mechanism 205 towards the cannula in the hybrid mode. In the hybrid mode, the orientation of the drive mechanism 205 can be controlled automatically to keep the drive mechanism 205 aligned with the cannula 235 or the remote center of the cannula 235. The processor can receive information indicative of a location of the robotic arm or ADM 205 from one or more sensors, such as from the first sensor 225. The processor can automatically and continuously orient the drive mechanism 205 with the cannula 235 in the hybrid mode, such that they always aligned. Also in the hybrid mode, the drive mechanism 205 may be translated towards the cannula 235 manually by a user. The location of the cannula 235 relative to the drive mechanism 205 is updated periodically through the one or more sensors, such as the first sensor 225. When the drive mechanism 205 is positioned close to the cannula 235, the location of the cannula 235 can be considered fixed based on the last sensor reading of the location of the cannula 235.

At block 508, the processor switches the system to the manual mode. Switching the robotic surgery system to the manual mode can include one or more of activating of a touch sensor, activating a switch, or applying force to a load cell, as described previously. The processor can receive the signal communicated from the user and the processor can switch to the manual mode.

At block 510, the drive mechanism 205 is translated towards the cannula 235 by the user in the manual mode. The ADM 205 can move or translate to a location close to the cannula 235. The ADM 205 can translate to a location close to the cannula 235, as described in FIG. 23. This step can also utilize a non-vision based sensor, such as the second sensor 220, positioned on the robotic arm or the drive mechanism 205 to aid the manual movement of the ADM 205 or robotic arm.

At block 512, the processor allows the user to manually move the drive mechanism 205 onto the cannula 235 in the manual mode. This step can be executed similar to the positions and method described in FIG. 24. Once the ADM 205 is brought close enough to the cannula 235 at block 510, a user can then manually dock the ADM 205 to the cannula 235.

3. Implementing Systems and Terminology.

Implementations disclosed herein provide systems, methods and apparatus for alignment and docking of a robotic arm.

It should be noted that the terms “couple,” “coupling,” “coupled” or other variations of the word couple as used herein may indicate either an indirect connection or a direct connection. For example, if a first component is “coupled” to a second component, the first component may be either indirectly connected to the second component via another component or directly connected to the second component.

The alignment and docking functions described herein may be stored as one or more instructions on a processor-readable or computer-readable medium. The term “computer-readable medium” refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such a medium may comprise random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that a computer-readable medium may be tangible and non-transitory. As used herein, the term “code” may refer to software, instructions, code or data that is/are executable by a computing device or processor.

The methods disclosed herein comprise one or more steps or actions for achieving the described method. The method steps and/or actions may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for proper operation of the method that is being described, the order and/or use of specific steps and/or actions may be modified without departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, a plurality of components indicates two or more components. The term “determining” encompasses a wide variety of actions and, therefore, “determining” can include calculating, computing, processing, deriving, investigating, looking up (e.g., looking up in a table, a database or another data structure), ascertaining and the like. Also, “determining” can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory) and the like. Also, “determining” can include resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expressly specified otherwise. In other words, the phrase “based on” describes both “based only on” and “based at least on.”

The previous description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other implementations without departing from the scope of the invention. For example, it will be appreciated that one of ordinary skill in the art will be able to employ a number corresponding alternative and equivalent structural details, such as equivalent ways of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing particular actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present invention is not intended to be limited to the implementations shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein. 

What is claimed is:
 1. A robotic surgery system comprising: a robotic arm; a drive mechanism attached to the robotic arm; a cannula; a first sensor coupled to either the robotic arm or the drive mechanism; a second sensor, that is different than the first sensor, coupled to either the robotic arm or the drive mechanism; at least one computer-readable memory having stored thereon executable instructions; and one or more processors in communication with the at least one computer-readable memory and configured to execute the instructions to cause the system to at least: direct automatic movement of the robotic arm towards the cannula based on data from the first sensor; and direct manual movement of the robotic arm towards the cannula based on data from the second sensor.
 2. The robotic surgery system of claim 1, wherein the first sensor comprises a vision-based sensor.
 3. The robotic surgery system of claim 2, wherein the vision-based sensor comprises a camera.
 4. The robotic surgery system of claim 2, wherein the vision-based sensor is attached to the drive mechanism.
 5. The robotic surgery system of claim 2, wherein the cannula further comprises a fiducial configured to be detected by the vision-based sensor.
 6. The robotic surgery system of claim 1, wherein the second sensor comprises a non-vision based sensor.
 7. The robotic surgery system of claim 6, wherein the non-vision based sensor comprises a force or torque sensor.
 8. The robotic surgery system of claim 6, wherein the non-vision based sensor is attached to the drive mechanism.
 9. The robotic surgery system of claim 6, wherein the non-vision based sensor comprises a switch.
 10. The robotic surgery system of claim 6, wherein the non-vision based sensor is positioned on a front end of the drive mechanism.
 11. The robotic surgery system of claim 6, wherein the non-vision based sensor is positioned on a back end of the drive mechanism.
 12. A robotic surgery system comprising: a robotic arm; a drive mechanism attached to the robotic arm; a cannula; a first sensor that is coupled to either the robotic arm or the drive mechanism; a second sensor that is coupled to either the robotic arm or the drive mechanism; at least one computer-readable memory having stored thereon executable instructions; and one or more processors in communication with the at least one computer-readable memory and configured to execute the instructions to cause the system to at least: automatically move the robotic arm in a first mode towards the cannula based on data from the first sensor; and manually move the robotic arm in a second mode based on data from the second sensor.
 13. The robotic surgery system of claim 12, wherein the first sensor comprises a vision-based sensor.
 14. The robotic surgery system of claim 13, wherein the vision-based sensor comprises a camera.
 15. The robotic surgery system of claim 13, wherein the vision-based sensor is attached to the drive mechanism.
 16. The robotic surgery system of claim 13, wherein the cannula further comprises a fiducial designed to be detected by the vision-based sensor.
 17. The robotic surgery system of claim 12, wherein the second sensor comprises a non-vision based sensor.
 18. The robotic surgery system of claim 17, wherein the non-vision based sensor comprises a force or torque sensor.
 19. The robotic surgery system of claim 17, wherein the non-vision based sensor comprises a switch.
 20. The robotic surgery system of claim 17, wherein the non-vision based sensor is attached to the drive mechanism. 